Korean J Gastroenterol.  2010 Jul;56(1):54-58. 10.4166/kjg.2010.56.1.54.

A Case of Locally Invasive Obstructive Jejunal Cancer with Curative Resection after Stenting and Chemotherapy

• Kim HK
• Ko BM
• Park JK
• Hong SJ
• Moon JH
• Lee JS
• Lee MS
• Kim BS

• KMID: 1775880
• DOI: http://doi.org/10.4166/kjg.2010.56.1.54

Abstract

Small bowel adenocarcinoma is a relatively rare malignancy. In Korea, 13.1% of small bowel adenocarcinoma occurs in the jejunum. The absence of effective screening methods and relatively obscure symptoms contribute to the higher percentage of advanced cases at the time of diagnosis. Although curative resection is the mainstay of treatment, it is often impossible. Chemotherapy and radiotherapy have shown a disappointing treatment result for advanced staged small bowel adenocarcinoma. We report a 54-year-old woman with locally invasive jejunal cancer who underwent curative resection after stent insertion with enteroscopy and chemotherapy.

Keyword

Jejunal neoplasm; Stents; Chemotherapy

Figure

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  Fig. 1. (A) Endoscopically, the stomach showed surrounding edematous mucosa and central erosion with extrinsic compression on the posterior wall of the upper body. (B) Exophytic low density mass in the duodenum with direct in-vasion to the stomach and colon in the abdominal computed tomography. (C) Small bowel enteroscopy showed encircling ulcerating mass on the jejunum. (D) The jejunum biopsy indicated moderately differentiated adenocarcinoma (H&E stain, ×100).

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  Fig. 2. (A) Stent was inserted on the jejunal obstruction site by push enteroscopy. (B) Abdominal computed tomograpy on the follow up showed markedly decreased size and invasiveness of jejunal cancer.

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  Fig. 3. The jejunal specimen after jejunal segmental resection showed marked fibrosis, necrosis, and chronic inflammation without re-sidual cancer (H&E stain, A: ×20, B: ×100).

Reference

1. Korea Central Cancer Registry. 2002 Annual report of the korea central cancer registry (based on registered data from 139 hospitals). 2003.

2. Greenstein AJ, Sachar DB, Smith H, Janowitz HD, Aufses AH Jr. A comparison of cancer risk in Crohn's disease and ulcerative colitis. Cancer. 1981; 48:2742–2745.

3. Offerhaus GJ, Giardiello FM, Krush AJ, et al. The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology. 1992; 102:1980–1982.

4. Jagelman DG, DeCosse JJ, Bussey HJ. Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet. 1998; 21:1149–1151.

5. Rodriguez-Bigas MA, Vasen HF, Lynch HT, et al. Characteristics of small bowel carcinoma in hereditary non-polyposis colorectal carcinoma. International Collaborative Group on HNPCC. Cancer. 1998; 83:240–244.

6. Howe JR, Karnell LH, Menck HR, Scott-Conner C. Adenocarcinoma of the small bowel: review of the national cancer data base, 1985-1995. Cancer. 1999; 86:2693–2706.

7. Stemmermann GN, Goodman MT, Nomura AM. Adenocarcinoma of the proximal small intestine. A marker for familial and multicentric cancer? Cancer. 1992; 70:2766–2771.

8. Ouriel K, Adams JT. Adenocarcinoma of the small intestine. Am J Surg. 1984; 147:66–71.

9. Czaykowski P, Hui D. Chemotherapy in small bowel adenocarcinoma: 10-year experience of the British Columbia Cancer Agency. Clin Oncol (R Coll Radiol). 2007; 19:143–149.

10. Dabaja BS, Suki D, Pro B, Bonnen M, Ajani J. Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer. 2004; 101:518–526.

11. Jigyasu D, Bedikian AY, Stroehlein JR. Chemotherapy for primary adenocarcinoma of the small bowel. Cancer. 1984; 53:23–25.

12. Crawley C, Ross P, Norman A, Hill A, Cunningham D. The Royal Marsden experience of small bowel adenocarcinoma treated with protracted venous infusion 5-fluorouracil. Br J Cancer. 1998; 78:508–510.

13. Coia L, Hoffman J, Scher R, et al. Preoperative chemo-radiation for adenocarcinoma of the pancrease and duodenum. Int J Radiat Oncol Biol Phys. 1994; 30:161–167.

14. Abrams RA, Grochow LB, Chakravarthy A, et al. Intensified adjuvant therapy for pancreatic and periampullary adenocarcinoma: survival results and observations regarding patterns of failure, radiotherapy dose and CA-19-9 levels. Int J Radiat Oncol Biol Phys. 1999; 44:1039–1046.

15. Fishman PN, Pond GR, Moore MJ, et al. Natural history and chemotherapy effectiveness for advanced adenocarcinoma of the small bowel: a retrospective review of 113 cases. Am J Clin Oncol. 2006; 29:225–231.

16. Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer. 2008; 44:1105–1115.

17. Yamamoto H, Kita H, Sunada K, et al. Clinical outcomes of double balloon endoscopy for the diagnosis and treatment of small intestinal diseases. Clin Gastroenterol Hepatol. 2004; 2:1010–1016.

18. Kita H, Yamamoto H, Yano T, et al. Double balloon endoscopy in two hundred fifty cases for the diagnsis and treatment of small intestinal disorders. Inflammopharmacology. 2007; 15:74–77.